Haemological conditions

Question 1

What is the most common cause of anaemia worldwide?

Answer 1

Iron deficiency anaemia

Question 2

Define anaemia in men over 15 years old

Question 3

Define anaemia in non-pregnant women over 15 and children aged 12-14

Question 4

Causes or iron deficiency may be classified int 4 categories. These are?

Answer 4

Excessive blood loss
Dietary inadequacy
Failure of iron absorption
Excessive requirements for iron

Question 5

What causes of excessive blood loss are there?

Answer 5

GI bleeding
Mennorrhagia
Maligancy (colonic, gastric)
Major surgery/trauma
Gastric/duodenal ulceration
NSAID use
Haemorrhoids

Question 6

What causes of failure of iron absorption are there?

Answer 6

Drugs (tetracyclines, quinolenes, antacids and PPI)
Malabsorption conditions (coeliac disease)
H. pylori colonisation

Question 7

What can cause an excessive requirement for iron?

Answer 7

Times of rapid growth in children
Pregnancy
Exfoliative skin disease

Question 8

How is iron deficiency anaemia diagnosis confirmed?

Answer 8

FBC (shows a hypochromic microcytic anaemia)
Serum ferritin
Blood film

Question 9

How does iron deficiency anaemia present?

Answer 9

Fatigue.
Shortness of breath on exertion.
Palpitations.
Sore tongue and taste disturbance.
Changes in the hair/hair loss.
Pruritus.
Headache.
Tinnitus.
Angina

Question 10

What are the symptoms of severe iron deficiency anaemia (Hb

Answer 10

SOB at rest
angina
ankle swelling

Question 11

Why is it important to ask about recent travel if iron deficiency anaemia is suspected?

Answer 11

Hookworm infestation from the tropics is possible

Question 12

Signs of iron deficiency anaemia?

Answer 12

Pallor
Koilonychia
Angular stomatitis
Atrophic glossitis
In marked anaemia, there may be tachycardia, a flow murmur, cardiac enlargement, ankle oedema and heart failure

Question 13

Differential diagnosis for iron deficiency anaemia?

Answer 13

Thalassaemia
Sideroblastic anaemia
Anaemia of chronic disease
Lead poisoning

Question 14

What investigations should be done iron deficient anaemia?

Answer 14

If MCV is reduced and a good history of menorrhagia oral iron may be started without further investigation. Otherwise investigate for GI blood loss.

Question 15

What investiagtions should be undertaken for GI blood loss?

Answer 15

Gastroscopy
sigmoidoscopy
barium enema
colonoscopy
stool microscopy
Iron deficiency with no obvious source of bleeding mandates careful GI workup

Question 16

What is the treatment for iron deficiency anaemia?

Answer 16

Treat the cause
Oral iron (ferous sulfate)

Question 17

What are the side effects to oral iron?

Answer 17

nausea
abdominal discomfort
diarrhoea/constipation
black stools
heartburn

Question 18

What is macrocytic anaemia?

Answer 18

When red blood cells are larger than normal and there is also a fall in haemoglobin levels in the blood. Normally occurs when there are problems with the synthesis of the blood cells (vitamin b12 or folic acid deficiency)

Question 19

How can we categorise macrocytic anaemia?

Answer 19

As megaloblastic and non-megaloblastic

Question 20

What does megaloblastic refer to?

Answer 20

an abnormality of the erythroblastsin the bone marrow in which the maturation of the nucleus is delayed relative to the cytoplasm
Results from defective DNA synthesis

Question 21

What are the two most common causes of macrocytic anaemia?

Answer 21

Medication (37%)

Alcoholism (26%

Question 22

What is the most common cause of megaloblastic

Answer 22

B12 deficiency or folic acid deficiency

Question 23

For how long can the livers store of vitamin B12 last?

Answer 23

4 years

Question 24

What is the most common cause of vitamin B12 deficiency?

Answer 24

Autoimmune Addisonian pernicious anaemia (80%)

Question 25

Causes of vitamin B12 deficiency (other than pernicious)

Answer 25

Post op (gastrectomy or ileal resection) Bacterial overgrowth HIV infection Dietary deficiency (rare)

Question 26

Causes of folate deficiency?

Answer 26

Dietary deficiency Malabsorption Increased demands (haemolysis, leukaemia) Increased urinary excretion (heart failure, acute hepatitis and dialysis) Drug induced

Question 27

Which drugs can cause folate deficiency?

Answer 27

``` Alcohol anticonvulsants methotrexate sulfasalazine trimethoprim ```

Question 28

Causes of non-megaloblastic macrocytosis

Answer 28

``` Alcohol abuse Liver disease Severe hyothyroidism Reticulocytosis Drugs ```

Question 29

How does macrocytosis present?

Answer 29

It doesn't cause any symptoms or signs but there may be features related to underlying disease. These symptoms are the same as those for microcytic anaemia

Question 30

What is the first line investigation for macrocytic anaemia?

Answer 30

FBC with examination of a blood film

Question 31

What test can be done to distinguish between megaloblastic and non-megaloblastic anaemia?

Answer 31

Bone marrow examination

Question 32

Management of macrocytic anaemia requires two components. These are?

Answer 32

Correcting the deficiency that has caused macrocytosis | Treating the underlying condition that led to the deficiency

Question 33

If low B12 id due to malabsorption what treatment can be given?

Answer 33

Hydroxocobalamin intra muscular injection every other day for 2 weeks

Question 34

What is the usual age of patients with pernicious anaemia?

Answer 34

>40

Question 35

What is deficient in pernicious anaemia resulting in B12 malabsorption?

Answer 35

Intrinsic factor (IF)

Question 36

If there is both folate and B12 deficiency which deficiency should be addressed first?

Answer 36

It is essential to start treating the B12 deficiency before starting folate before the latter may aggravate the B12 deficiency and precipitate subacute combined degeneration of the cord